PROGNOSTIC FACTORS AND SURVIVAL OF PATIENTS WITH SARCOMATOID RENAL CELL CARCINOMA
Abstract
Purpose:
Sarcomatoid renal cell carcinoma often has an aggressive clinical course characterized by rapid disease progression. We evaluate prognostic factors for patient survival and the effect of treatment on patient outcome.
Materials and Methods:
Between 1987 and 1998, 108 patients were classified as having sarcomatoid renal cell carcinoma at our institution. We reviewed the records of these patients to identify clinical and pathological prognostic variables. The Kaplan-Meier method was used to determine differences in overall survival.
Results:
A total of 96 (89%) patients were symptomatic at presentation. Sarcomatoid renal cell carcinoma was localized to the kidney in 25 (23%) patients, whereas metastasis was present in 83 (77%). The median overall survival of all patients was 9 months. The presence of clinically localized disease was associated with longer overall survival when compared to patients with metastasis (17 versus 7 months, respectively, p <0.004). Of 86 patients who received systemic therapy partial response was seen in 28, and no complete responses were noted. Patients who had a partial response had a median survival of 19 months and those with no response 7 (p <0.005). Those patients with metastatic disease who were treated with nephrectomy followed by systemic therapy survived a median time of 8.5 months, whereas those who received systemic therapy alone 5.3 (p = 0.08).
Conclusions:
Patients with sarcomatoid renal cell carcinoma have poor overall survival because of the aggressive biological behavior. Survival is longer for patients presenting with clinically localized disease, single metastatic site, and exhibiting a partial response to systemic therapy.
References
- 1 : Sarcomatoid renal carcinoma. J Urol1983; 130: 657. Link, Google Scholar
- 2 : Sarcomatoid renal cell carcinoma: clinicopathologic. A study of 42 cases. Cancer1987; 59: 516. Crossref, Medline, Google Scholar
- 3 : Sarcomatoid renal cell carcinoma. A treatable entity. Cancer1987; 60: 1313. Crossref, Medline, Google Scholar
- 4 : Sarcomatoid carcinoma of the kidney. J Urol1987; 137: 25. Link, Google Scholar
- 5 : Sarcomatoid renal cell carcinoma. A study of its proliferative activity. Cancer1993; 71: 2292. Google Scholar
- 6 : Treatment of sarcomatoid renal cell carcinoma: is there a role for chemotherapy?. Eur Urol1995; 27: 138. Crossref, Medline, Google Scholar
- 7 : Sarcomatoid renal cell carcinoma: biologic behavior, prognosis, and response to combined surgical resection and immunotherapy. J Clin Oncol1999; 17: 523. Google Scholar
- 8 : Manual for Staging of Cancer, 5th ed. Philadelphia: Lippincott-Raven1997: 231. Google Scholar
- 9 : Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol1982; 6: 655. Crossref, Medline, Google Scholar
- 10 : Cytoreduction nephrectomy in metastatic renal cancer: the results of Southwest Oncology Group Trial 8949. J Urol2000; 163: 154. abstract 685. Google Scholar
- 11 : Tumor nephrectomy plus interferon α is superior to interferon α alone in metastatic renal cell carcinoma. J Urol2000; 163: 176. abstract 778. Google Scholar
- 12 : Chemoimmunotherapy of sarcomatoid renal cell carcinoma. Med Pediatr Oncol1978; 5: 9. Crossref, Medline, Google Scholar
- 13 : Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol1999; 17: 2530. Crossref, Medline, Google Scholar
- 14 : The Heidelberg classification of renal cell tumours. J Pathol1997; 183: 131. Crossref, Medline, Google Scholar
- 15 : Classification of renal cell carcinoma: Workgroup No. 1. Union Internationale Contre le Cancer (UICC) and the American Joint Committee on Cancer (AJCC). Cancer1997; 80: 987. Crossref, Medline, Google Scholar
- 16 : Sarcomas and sarcomatoid and mixed malignant tumors of the kidney in adults. 3. Cancer1968; 22: 556. Google Scholar
From the Departments of Urology, Surgical Oncology and GU Medical Oncology, University of Texas, M. D. Anderson Cancer Center, Houston, Texas
